APPLICATION FOR PHOTO ID CARD Systems, Inc.

USAID
Systems, Inc.
APPLICATION FOR PHOTO ID CARD
SERIAL NUMBER
DATE
FORM AP - 0042 - 199/2000
ISSUED IN ACCORDANCE WITH U.S. FEDERAL REGULATIONS.
IMPORTANT NOTICE!
It is against the law to make false statements on this application!
By signing this application and applying for the USAID card, you agree to the following terms and conditions: The USAID card is
issued based upon the information and documents you supply to us. You are solely responsible for the information printed on the card,
as well as for the use you make of it. False representations are punishable by the law and will be reported to the competent authorities.
DO NOT PROCESS THIS APPLICATION WITHOUT A COPY OF OFFICIAL PROOF OF AGE.
A COPY OF DOCUMENT ATTESTING TO THE DATE OF BIRTH OF APPLICANT MUT BE SUBMITTED WITH THIS APPLICATION.
LAST NAME / Apellido Paterno
M .I.
FIRST NAME / Primer Nombre
DATE OF BIRTH
Fecha de Nacimiento
MONTH
SEX (Gender)
HEIGHT / Estatura
WEIGHT / Peso
COLOR OF EYES
DAY
YEAR
COLOR OF HAIR
APPLICANTíS PERMANENT ADDRESS / Domicilio Permanente del Solicitante
Emergency Telephone Number:
NON GOVERNMENT ISSUED CARD - READ AND COMPLETE BACK SIDE OF THIS APPLICATION FOR
ADDITIONAL LEGAL INFORMATION
Under penalty of perjury, I Certify that I have read and that I understand the terms and conditions stated herein, and that
all the information and documents furnished by myself, and contained in this application are true and correct to the best
of my knowledge, and that I will use this ID Card only for lawful and legal purposes. I also certify that I fully understand
that this is not a government issued document, and this USAID Systems, Inc. is not a government-affiliated organization.
APPLICANTíS SIGNATURE / Firma del Solicitante
APPLICANTíS PHOTOGRAPH
Foto del aplicante
AGENTíS NAME / Nombre de la
C
COPYRIGHT 2006 - All rights reserved.
Agencia
USAID Systems, Inc. - PO. Box 630746 ,Miami, FL 33163
www.usaidsystems.com
630746
USAID Systems,Inc.
19597 NE 10th Ave. Bldg 6 Suite L
Miami- Fl 33179
[email protected]
(305)655-0049 /
(305) 655-0277
INSTRUCTIONS ON HOW TO PREPARE THE USAID CARD APPLICATION
INSTRUCCIONES COMO PREPARAR LA APLICACION PARA LA TARJETA USAID
1.-Complete the entire application including the affidavit on the back and notarize it.
Complete la aplicación incluyendo la declaración jurada en la parte de atras y notaricelo.
2.-Provide a copy of one of the documents listed in part 2 on the back, notarized.
Envie una copia notarizada de uno de los documentos listados en parte 2 de la aplicación.
3.-Place a photo where it says “applicant’s photograph”.
Coloque una foto donde se indica “applicant’s photograph”.
4.-Make sure you mail one money order for the amount of applications you are sending.
Asegurese de adjuntar un money order por la cantidad de aplicaciones que este mandando.
5.-Make money order payable to USA ID for $40.00
Haga el money order a la orden de USA ID por $40.00
6.-Please allow seven business days prior to receiving the Id’s.
Permitanos un margen de siete días habiles para recibir las tarjetas.
7.-Mail the Application’s to the address above.
Favor de enviar las aplicaciones a la dirección indicada mas arriba .
8.-Also you can send the application and documents (Notarized) to our email address and the
color picture ,scanned as PDF the documents and Jpeg the picture .(Using this method we are
charging the total amount to your debit or credit card)
Tambien puedes enviarnos la aplicación y documentos escaneados( Notarizados) a nuestro
correo electrónico,escaneando los documentos en formato de PDF y la fotografía en formato
de Jpeg (Usando este método estaremos cobrando los valores a su tarjeta de debito o crédito).